Adapting an existing program for implementation in your desired environment can be both effective and efficient. If you can identify an existing program that has already been proven to have an impact on a desired outcome, then you must first determine whether it is possible to adapt the program to your target population and setting; not all successful programs can be adapted successfully.
The steps presented in the Guide for designing a new alcohol education program should also be followed when adapting an existing program: Background research (Getting Started), Program Design, Implementation, and Evaluation. These steps, as they apply to program adaption are more fully described below. Remember, evaluation is a critical component of any good alcohol education program. Just because a program has been evaluated in the past does not mean it will be effective in a new context. Replications and especially adaptations require further evaluations.
Background Research
If you decide to adapt an evidence-based practice (EBP) or a good practice program, it is always a good idea to consult with the program developer for permission. Also, there might be readily available adaptations and materials for your intended target population, or some recommendations about how to adapt the program to a different context.
Program Design
A program that was successful in one context will not necessarily have the same effectiveness when implemented elsewhere. In order to help ensure that your adaptation is successful, there are a few steps we recommend you to take during the adaptation process:
- Change the language: This may sound fairly simple, however, consider that one country or region might have several languages (for example, China or India). You might decide to work in a certain area in which a particular language is predominant, but if you want to reach the most vulnerable groups you may need to use their preferred language. You will also need to consider also the name of your program; direct translations don’t always work well. The name should be appealing and appropriate for your target audience. For example, the successful “Strengthening Families Program” has been translated into “Familias Fuertes” (Strong Families) in its Latin American version.
- Translate, adapt and/or modify vocabulary: Consider regional variations in language. If you want to create a program for a large and relatively homogeneous region (i.e. Latin America) you might consider using a standard language that will be understood by the broadest possible segment of the population, this approach can also help improve cost effectiveness. Remember to keep in mind the age of your target audience and their preferred language style in order to tailor your program.
- Replace images: You will need to show individuals, scenes, and contexts that look like your target audience and their environment.
- Replace cultural references: The identification of appropriate cultural references should be done in collaboration with your local counterparts and the program developer to ensure relevance with your new target audience.
- Modify some aspects of the activities: You need to ensure that program activities are appropriate for your new target audience. For example, in some cultural contexts gender roles are especially important, and it is recommended that men and women be separated during program delivery. Gender roles can also be important in selecting facilitators for each group.
- Add relevant, evidence‐based content: This can make the program more appealing to your new target audience. This should be informed by your background research and interactions with local counterparts. You need to find out what works in these communities.
Implementation
Once you have adapted the chosen program to your social and cultural context you need to pilot test it with your target audience.
Using the information you collected during your formative research and the results of your pilot test, you can further refine your program materials and protocols before proceeding with the full-scale implementation.
Sometimes, adaptations can jeopardize the effectiveness of your intervention, for that reason you should monitor your program carefully to assess what is, or is not working, and how these issues can be addressed.
Threats to Successful Program Adaptation
As we pointed out previously, with program adaptations there are certain issues that you should be paying close attention to:
- Changing the theoretical approach: There is no better theory than a good program and changing the theoretical approach will change the very nature of your intervention. So by changing the theory behind it you will be using an untested, unreliable approach. If you are convinced that a change in theory is necessary you will have to create a new program and pilot test it in order to assess its effectiveness.
- Eliminating key messages or skills: Key messages (the core elements of the intervention) are what make programs effective and will generate a set of skills that are very important to replicate on a consistent basis. It is strongly recommended that you do not eliminate the original key messages.
- Using staff or volunteers who are not adequately trained or qualified: The success of your program depends on the quality of the delivery. You should pay close attention to the recruitment and training of program staff and assess their performance on a regular basis, using debriefs or observations.
- Using fewer staff members than recommended: In a situation in which you don’t have enough adequately trained staff, you may have to rely on fewer staff members to implement your program. This should also be monitored to ensure effective program delivery.
- Lowering the level of participant engagement: Some programs might be tempted to lower the level of participant engagement just to retain participants. While retention rates are important, much of your program's success relies on adequate engagement of the target audience.
- Reducing the number or length of sessions or how long participants are involved: This can be a hard decision to make so you will need to work closely with your local counterparts and, at the same time, pay close attention to the core components of the intervention so that by reducing the length or the involvement of participants you are sure you are still addressing the key elements of your program. Also bear in mind that dosage is an important factor in program effectiveness, so you would should have to pilot a program to test these kinds of adaptations.
- Removing topics. An evidence-based or a good practice program is usually the product of a combination of the theoretical approach and an appropriate methodology and should be considered as a whole entity. Removing a topic that is part of the intervention’s core will most likely have a negative impact on the effectiveness of your intervention.
